Diagnostic Roles Of Pleural Biopsy By Medical Thoracoscopy

Objective:To evaluate the diagnostic roles of pleural biopsy by medical thoracoscopy in unknown causes pleural effusions,diffuse bilateral lung disease and nodular or mass subpleury.Methods:The data of medical thoracoscopy in 53 hospitalized patients from September 2009 to September 2010 with pleural effusion of unknown reason,or diffuse bilateral lung disease,or nodular and subpleury mass was retrospectively analyzed.Results:The profile of endoscopic pleura can be divided into the following four types:1.pleural edema,hypertrophy of the rough. 2.single or multiple white or yellow nodules. 3.the formation of adhesions. 4. no significant performance. 38 cases of 53 patients in this group were diagnosed pathologically, with the overall diagnosis rate of 71.70%(38/53). The pathological diagnosis rate was of 71.05%(27/38)for 38 cases with pleural effusion of unknown causes.Among them, 6 cases were diagnosed as adenocarcinoma , 4 cases as pleural mesothelioma , 1 case as bronchioloalveolar carcinoma , 1 case as small cell lung cancer , 1 case as metastatic tumor , 1case as squamous carcinoma , 11 cases as tuberculous pleurisy ,1 case as lymphangioleiomyomatosis and 1 case as lung bullae. The pathological diagnosis rate was of 73.3% for the 15 cases with diffuse bilateral lung disease, or nodular or mass subpleury (11/15)whose bronchoscopy lung biopsy or percutaneous lung biopsy failed to confirmed .Among them ,3 case were diagnosed as metastatic tumors , 2 cases as adenocarcinoma ,4 cases as secondary pulmonary tuberculosis, 1 case as non-specific interstitial pneumonia and 1 case as cryptogenic organizing pneumonia. Pleural reaction happened to 1 patient when his pleura was bited . The operation was stopped immediately ,and high flow oxygen was provided and other treatment was carried out to improve patient's condition.Postoperative wound pain and subcutaneous emphysema were more common complications.Conclusions:Medical thoracoscopy is a safe,simple,efficient and acceptable method in unknown causes pleural effusions, bilatera diffusel lung disease and nodular or mass subpleury.Multi-site biopsy of suspicious lesions can improve the diagnostic efficacy. Diagnostic efficiency of medical thoracoscopy biospy in patients considered as malignant disease by pulmonary physicians is higher than that of benign disease.